Sample PLR Content Directory Idaho: insulin regular

Generic Name: insulin regular (IN soo lin REG yoo lar)

Brand Names: HumuLIN R, NovoLIN R, NovoLIN R Innolet, NovoLIN R PenFill, ReliOn/NovoLIN R

What is insulin regular?

Insulin is a hormone that is produced in the body. It works by lowering levels of glucose (sugar) in the blood. Insulin regular is a short-acting form of insulin.

Insulin regular is used to treat diabetes.

Insulin regular may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about insulin regular?

Take care not to let your blood sugar get too low. Low blood sugar (hypoglycemia) can occur if you skip a meal, exercise too long, drink alcohol, or are under stress. Symptoms include headache, hunger, weakness, sweating, tremors, irritability, or trouble concentrating. Carry hard candy or glucose tablets with you in case you have low blood sugar. Other sugar sources include orange juice and milk. Be sure your family and close friends know how to help you in an emergency.

Also watch for signs of blood sugar that is too high (hyperglycemia). These symptoms include increased thirst, increased urination, hunger, dry mouth, fruity breath odor, drowsiness, dry skin, blurred vision, and weight loss. Your blood sugar will need to be checked often, and you may need to adjust your insulin dose.

Never share an injection pen or cartridge with another person. Sharing injection pens or cartridges can allow disease such as hepatitis or HIV to pass from one person to another.

Insulin is only part of a complete program of treatment that may also include diet, exercise, weight control, foot care, eye care, dental care, and testing your blood sugar. Follow your diet, medication, and exercise routines very closely. Changing any of these factors can affect your blood sugar levels.

Do not change the brand of insulin or syringe you are using without first talking to your doctor or pharmacist. Some brands of insulin regular and syringes are interchangeable, while others are not. Your doctor and/or pharmacist know which brands can be substituted for one another.

What should I discuss with my healthcare provider before using insulin regular?

Do not use this medication if you are allergic to insulin, or if you are having an episode of hypoglycemia (low blood sugar).

To make sure you can safely use insulin, tell your doctor if you have liver or kidney disease.

Tell your doctor about all other medications you use, including any oral (by mouth) diabetes medications.

Insulin regular is only part of a complete program of treatment that may also include diet, exercise, weight control, foot care, eye care, dental care, and testing your blood sugar. Follow your diet, medication, and exercise routines very closely. Changing any of these factors can affect your blood sugar levels.

FDA pregnancy category B. Insulin is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether insulin regular passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I use insulin regular?

Use exactly as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

Your blood sugar will need to be checked often, and you may need other blood tests at your doctor's office. Visit your doctor regularly.

Insulin regular is injected under the skin. You may be shown how to use injections at home. Do not self inject this medicine if you do not fully understand how to give the injection and properly dispose of used needles and syringes.

Choose a different place in your injection skin area each time you use this medication. Do not inject into the same place two times in a row.

Insulin regular should look as clear as water. Do not use the medication if has changed colors, looks cloudy, or has particles in it. Call your doctor for a new prescription.

Use a disposable needle only once. Throw away used needles in a puncture-proof container (ask your pharmacist where you can get one and how to dispose of it). Keep this container out of the reach of children and pets.

Some types of insulin needles can be used more than once. But reusing needles increases your risk of infection. Used needles must be properly cleaned and inspected for bending or breakage. Ask your doctor or pharmacist whether you can reuse your insulin needles.

Never share an injection pen or cartridge with another person. Sharing injection pens or cartridges can allow disease such as hepatitis or HIV to pass from one person to another. Know the signs of low blood sugar (hypoglycemia) and how to recognize them: headache, hunger, weakness, sweating, tremors, irritability, or trouble concentrating.

Always keep a source of sugar available in case you have symptoms of low blood sugar. Sugar sources include orange juice, glucose gel, candy, or milk. If you have severe hypoglycemia and cannot eat or drink, use an injection of glucagon. Your doctor can give you a prescription for a glucagon emergency injection kit and tell you how to give the injection.

Check your blood sugar carefully during a time of stress or illness, if you travel, exercise more than usual, drink alcohol, or skip meals. These things can affect your glucose levels and your dose needs may also change.

Your doctor may want you to stop taking insulin for a short time if you become ill, have a fever or infection, or if you have surgery or a medical emergency.

Ask your doctor how to adjust your insulin dose if needed. Do not change your medication dose or schedule without your doctor's advice.

If your doctor changes your brand, strength, or type of insulin, your dosage needs may change. Ask your pharmacist if you have any questions about the new kind of insulin you receive at the pharmacy.

Carry an ID card or wear a medical alert bracelet stating that you have diabetes, in case of emergency. Any doctor, dentist, or emergency medical care provider who treats you should know that you are diabetic.

Storing unopened vials and cartridges: Keep in the carton and store in a refrigerator, protected from light. Unopened vials may also be stored at room temperature, away from heat and bright light.

Storing after your first use: Keep the "in-use" vials or cartridges at room temperature.

Do not freeze insulin regular, and throw away the medication if it has become frozen.

Throw away any insulin not used before the expiration date on the medicine label.

What happens if I miss a dose?

Since insulin regular is used before meals or snacks, you may not be on a timed dosing schedule. Whenever you use insulin regular, be sure to eat a meal or snack within 15 to 30 minutes. Do not use extra insulin to make up a missed dose.

It is important to keep insulin regular on hand at all times. Get your prescription refilled before you run out of medicine completely.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An insulin overdose can cause life-threatening hypoglycemia.

Symptoms of severe hypoglycemia include extreme weakness, blurred vision, sweating, trouble speaking, tremors, stomach pain, confusion, and seizure (convulsions).

What should I avoid while using insulin regular?

Do not change the brand of insulin regular or syringe you are using without first talking to your doctor or pharmacist. Avoid drinking alcohol. Your blood sugar may become dangerously low if you drink alcohol while using insulin regular.

Insulin regular side effects

Get emergency medical help if you have any of these signs of insulin allergy: itching skin rash over the entire body, wheezing, trouble breathing, fast heart rate, sweating, or feeling like you might pass out.

Hypoglycemia, or low blood sugar, is the most common side effect of insulin. Symptoms include headache, hunger, weakness, sweating, tremors, irritability, trouble concentrating, rapid breathing, fast heartbeat, fainting, or seizure (severe hypoglycemia can be fatal). Carry hard candy or glucose tablets with you in case you have low blood sugar.

Tell your doctor if you have itching, swelling, redness, or thickening of the skin where you inject insulin.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Insulin regular Dosing Information

Usual Adult Dose for Gestational Diabetes:

Regular insulin is a short-acting insulin and is generally injected subcutaneously 2-5 times daily within 30-60 minutes before a meal.

Insulin dosage should be individualized to achieve/maintain a target blood glucose level and is determined by various factors including body weight, body fat, physical activity, insulin sensitivity, blood glucose levels, and target blood glucose.

Conventional regimen: The total daily insulin dose is administered as a mixture of rapid/short-acting and intermediate-acting insulins in 1-2 injections. Twice daily injections are preferred for better glycemic control. With the 2-injection regimen, generally two-thirds of the daily dose is given before breakfast and one-third is given before the evening meal.

Intensive regimen: The total daily dose is administered as 3 or more injections or by continuous subcutaneous infusion to cover basal and pre-meal bolus insulin requirements. The basal requirement is approximately 30-50% of the total dose, given as intermediate or long-acting insulin (NPH, zinc, extended zinc, lispro-protamine, glargine), 1-2 times daily. Meal boluses are approximately 50-70% of the total dose, given as rapid/short-acting insulin (regular, aspart, lispro) 2-5 times daily before meals. Common regimens include injections of rapid/short acting insulin before each meal along with injections of intermediate or long-acting insulin in the morning and/or evening. Dosage adjustments are made to achieve target blood glucose levels and are based on frequent blood glucose measurements, diet and exercise levels.

Total daily insulin requirements:
Initial dose: 0.5-0.8 unit/kg/day subcutaneously
Honeymoon phase: 0.2-0.5 unit/kg/day subcutaneously
Split dose therapy: 0.5-1.2 unit/kg/day subcutaneously
Insulin resistance: 0.7-2.5 units/kg/day subcutaneously

Usual Adult Dose for Diabetes Mellitus Type I:

Usual Adult Dose for Diabetes Mellitus Type II:

Regular insulin is a short-acting insulin and should be injected within 30-60 minutes before a meal.

Diet and lifestyle modifications are recommended as initial treatment for type II diabetes, followed by oral agents. Insulin may be considered if patients are very hyperglycemic or symptomatic and/or not controlled with oral agents. Insulin may exacerbate obesity, further increase insulin resistance, and increase the frequency of hypoglycemia.

Insulin dosage should be individualized to achieve/maintain a target blood glucose level and is determined by various factors including body weight, body fat, physical activity, insulin sensitivity, blood glucose levels, and target blood glucose.

Conventional regimen:
Initial dose, monotherapy: Total daily requirement: 0.1 unit/kg/day subcutaneously. When insulin is used alone, twice daily injections are recommended for better glycemic control. The total daily insulin dose is administered as a mixture of rapid/short-acting and intermediate-acting insulins in 1-2 injections. With the 2-injection regimen, generally two-thirds of the daily dose is given before breakfast and one-third is given before the evening meal. Once daily injections are sometimes used in children with suboptimal compliance; however, this may lead to more nocturia, fasting hyperglycemia, morning glucosuria, and a risk of ketoacidosis if the doses are missed.
Maintenance dose, monotherapy: Total daily insulin requirements may progress to 1.5-2.5 units/kg or higher in patients with obesity and insulin resistance.

Intensive regimen:
The necessity for and efficacy of intensive insulin therapy in type II diabetes has been controversial. The total daily dose is administered as 3 or more injections or by continuous subcutaneous infusion to cover basal and pre-meal bolus insulin requirements. This method may be appropriate for closely supervised and highly motivated older children or adolescents who are able to inject their insulin, monitor their blood glucose, and recognize hypoglycemia. The basal requirement is approximately 30-50% of the total dose, given as intermediate or long-acting insulin (NPH, zinc, extended zinc, lispro-protamine, glargine), 1-2 times daily. Meal boluses are approximately 50-70% of the total dose, given as rapid/short-acting insulin (regular, aspart, lispro) 2-5 times daily before meals. Common regimens include injections of rapid/short acting insulin before each meal along with injections of intermediate or long-acting insulin in the morning and/or evening. Dosage adjustments are made to achieve target blood glucose levels and are based on frequent blood glucose measurements, diet and exercise levels.
Initial dose, monotherapy: 0.5-1.5 unit/kg/day subcutaneously.
Maintenance dose, monotherapy: Total daily insulin requirements may progress to 2.5 units/kg or higher in patients with obesity and insulin resistance.

Usual Adult Dose for Diabetic Ketoacidosis:

Begin after intravenous fluid/electrolyte therapy has been initiated:
Initial dose: 10-20 units IV or 20 units IM or 0.1 unit/kg IM or IV.
Maintenance dose: 0.1 unit/kg/hour by continuous IV infusion in normal saline; monitor blood glucose hourly and adjust rate to gradually decrease plasma glucose. Usual range is 0.05-0.2 units/kg/hour. Switch patients to subcutaneous insulin after recovery from the acute episode.
or
5-10 units IM hourly
or
0.5-4 units/hour by continuous IV infusion to achieve a maximal blood glucose decrease of 50 mg/dL/hour.

Usual Adult Dose for Growth Hormone Reserve Test:

0.05-1.5 units/kg one time by rapid IV push. Monitor patient closely.

Usual Adult Dose for Hyperkalemia:

Begin after administration of calcium gluconate and sodium bicarbonate IV:
10-20 units IV once with 25-50 g dextrose.

Usual Adult Dose for Insulin Resistance:

Total daily insulin requirements range from 0.7 to 2.5 units/kg. Concentrated insulin (500 units/mL) may be used for patients taking more than 200 units/day to allow for reasonable subcutaneous dose volumes.

Usual Adult Dose for Nonketotic Hyperosmolar Syndrome:

Begin after intravenous fluid therapy has been initiated:
Initial dose: 5-10 units or 0.1 unit/kg IV once
Maintenance dose: 0.05-0.1 unit/kg/hour by continuous IV infusion. Monitor vital signs, cardiovascular status, I/O, and plasma glucose and potassium levels. Add potassium to the IV to correct hypokalemia. Add dextrose to the IV once glucose levels reach 250 mg/dL to avoid hypoglycemia. Switch patients to subcutaneous insulin therapy after recovery from the acute episode.

Usual Pediatric Dose for Diabetes Mellitus Type I:

Regular insulin is a short-acting insulin and is generally injected subcutaneously 2-5 times daily within 30-60 minutes before a meal.

Insulin dosage should be individualized to achieve/maintain a target blood glucose level and is determined by various factors including body weight, body fat, physical activity, insulin sensitivity, blood glucose levels, and target blood glucose.

Conventional regimen: The total daily insulin dose is administered as a mixture of rapid/short-acting and intermediate-acting insulins in 1-2 injections. Twice daily injections are recommended for better glycemic control. With the 2-injection regimen, generally two-thirds of the daily dose is given before breakfast and one-third is given before the evening meal. Once daily injections are sometimes used in children with suboptimal compliance; however, this may lead to more nocturia, fasting hyperglycemia, morning glucosuria, and a risk of ketoacidosis if the doses are missed.

Intensive regimen: The total daily dose is administered as 3 or more injections or by continuous subcutaneous infusion to cover basal and pre-meal bolus insulin requirements. This method may be appropriate for closely supervised and highly motivated older children or adolescents who are able to inject their insulin, monitor their blood glucose, and recognize hypoglycemia. The basal requirement is approximately 30-50% of the total dose, given as intermediate or long-acting insulin (NPH, zinc, extended zinc, glargine), 1-2 times daily. Meal boluses are approximately 50-70% of the total dose, given as rapid/short-acting insulin (regular, lispro) 2-5 times daily before meals. Common regimens include injections of rapid/short acting insulin before each meal along with injections of intermediate or long-acting insulin in the morning and/or evening. Dosage adjustments are made to achieve target blood glucose levels and are based on frequent blood glucose measurements, diet and exercise levels.

Total daily insulin requirements:
Initial dose: 0.5-0.8 unit/kg/day subcutaneously
Honeymoon phase: 0.2-0.5 unit/kg/day subcutaneously
Split dose therapy: 0.5-1.2 unit/kg/day subcutaneously
Adolescents during growth spurts. 0.8-1.5 units/kg/day subcutaneously

Usual Pediatric Dose for Diabetes Mellitus Type II:

Regular insulin is a short-acting insulin and should be injected within 30-60 minutes before a meal.

Diet and lifestyle modifications are recommended as initial treatment for type II diabetes, followed by oral agents (metformin). Insulin may be considered if children are very hyperglycemic or symptomatic and/or not controlled with oral agents. Insulin may exacerbate obesity, further increase insulin resistance, and increase the frequency of hypoglycemia.

Insulin dosage should be individualized to achieve/maintain a target blood glucose level and is determined by various factors including body weight, body fat, physical activity, insulin sensitivity, blood glucose levels, and target blood glucose.

Conventional regimen:
Initial dose, monotherapy: Total daily requirement: 0.1 unit/kg/day subcutaneously. When insulin is used alone, twice daily injections are recommended for better glycemic control. The total daily insulin dose is administered as a mixture of rapid/short-acting and intermediate-acting insulins in 1-2 injections. With the 2-injection regimen, generally two-thirds of the daily dose is given before breakfast and one-third is given before the evening meal. Once daily injections are sometimes used in children with suboptimal compliance; however, this may lead to more nocturia, fasting hyperglycemia, morning glucosuria, and a risk of ketoacidosis if the doses are missed.
Maintenance dose, monotherapy: Total daily insulin requirements may progress to 1.5-2.5 units/kg or higher in patients with obesity and insulin resistance.

Intensive regimen:
The necessity for and efficacy of intensive insulin therapy in type II diabetes has been controversial. The total daily dose is administered as 3 or more injections or by continuous subcutaneous infusion to cover basal and pre-meal bolus insulin requirements. This method may be appropriate for closely supervised and highly motivated older children or adolescents who are able to inject their insulin, monitor their blood glucose, and recognize hypoglycemia. The basal requirement is approximately 30-50% of the total dose, given as intermediate or long-acting insulin (NPH,zinc, extended zinc, glargine), 1-2 times daily. Meal boluses are approximately 50-70% of the total dose, given as rapid/short-acting insulin (regular, lispro) 2-5 times daily before meals. Common regimens include injections of rapid/short acting insulin before each meal along with injections of intermediate or long-acting insulin in the morning and/or evening. Dosage adjustments are made to achieve target blood glucose levels and are based on frequent blood glucose measurements, diet and exercise levels.
Initial dose, monotherapy: 0.5-1.5 unit/kg/day subcutaneously.
Maintenance dose, monotherapy: Total daily insulin requirements may progress to 2.5 units/kg or higher in patients with obesity and insulin resistance.

Usual Pediatric Dose for Diabetic Ketoacidosis:

Begin after intravenous fluid/electrolyte therapy has been initiated:
Initial dose: 0.1-0.25 unit/kg IM or IV
Maintenance dose: 0.1 unit/kg/hour by continuous IV infusion in normal saline or 0.05-0.1 unit/kg/hour by IM or subcutaneous injection. Monitor blood glucose hourly and adjust rate to gradually decrease plasma glucose. Usual range is 0.05-0.3 units/kg/hour. Switch patients to subcutaneous insulin after recovery from the acute episode.

Usual Pediatric Dose for Growth Hormone Reserve Test:

0.05-1.5 units/kg one time by rapid IV push. Monitor patient closely.

Usual Pediatric Dose for Hyperkalemia:

Begin after administration of calcium gluconate and sodium bicarbonate IV:
0.25-1 g/kg dextrose with 1 unit regular insulin per 3-5 g dextrose infused IV over 2 hours.
or
0.25-1 g/kg dextrose infused IV over 15-30 minutes, then give 0.1 unit/kg regular insulin subcutaneously or IV.
or
0.05-0.1 unit/kg/hour regular insulin infused IV with dextrose. 1 unit insulin per 1.9-3.9 g dextrose ratio has been used in premature infants. Adjust rate to target blood glucose level.

Usual Pediatric Dose for Insulin Resistance:

True insulin resistance is rare in children. Daily requirements may be greater than 2 units/kg. Extreme insulin resistance with insulin requirements greater than 10 units/kg/day has been reported in children with acanthosis nigricans and polycystic ovaries.

Concentrated insulin (500 units/mL) may be used for patients taking more than 200 units/day to allow for reasonable subcutaneous dose volumes.

Usual Pediatric Dose for Nonketotic Hyperosmolar Syndrome:

Begin after intravenous fluid therapy has been initiated:
Initial dose: 0.05-0.1 unit/kg IV once
Maintenance dose: 0.05 unit/kg/hour by continuous IV infusion. Monitor vital signs, cardiovascular status, I/O, and plasma glucose and potassium levels. Add potassium to the IV to correct hypokalemia. Add dextrose to the IV once glucose levels reach 250 mg/dL to avoid hypoglycemia. Switch patients to subcutaneous insulin therapy after recovery from the acute episode.

What other drugs will affect insulin regular?

Using certain medicines can make it harder for you to tell when you have low blood sugar. Tell your doctor if you use any of the following:

albuterol (Proventil, Ventolin);

clonidine (Catapres);

reserpine; or

beta-blockers such as atenolol (Tenormin, Tenoretic), carvedilol (Coreg), labetalol (Normodyne, Trandate), metoprolol (Dutoprol, Lopressor, Toprol), nadolol (Corgard), propranolol (Inderal, InnoPran), sotalol (Betapace), and others.

These lists are not complete and there are many other medicines that can increase or decrease the effects of insulin on lowering your blood sugar. Tell your doctor about all medications you use. This includes prescription, over the counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

More insulin regular resources

Insulin regular Side Effects (in more detail)
Insulin regular Dosage
Insulin regular Use in Pregnancy & Breastfeeding
Insulin regular Drug Interactions
Insulin regular Support Group
2 Reviews for Insulin regular - Add your own review/rating

Insulin Regular MedFacts Consumer Leaflet (Wolters Kluwer)

Humulin R MedFacts Consumer Leaflet (Wolters Kluwer)

Humulin R Prescribing Information (FDA)

Novolin R Prescribing Information (FDA)

Compare insulin regular with other medications

Diabetes, Type 1
Diabetes, Type 2
Diabetic Ketoacidosis
Gestational Diabetes
Growth Hormone Reserve Test
Hyperkalemia
Insulin Resistance Syndrome
Nonketotic Hyperosmolar Syndrome

Where can I get more information?

Your pharmacist can provide more information about insulin regular.

See also: insulin regular side effects (in more detail)

Sample PLR Content Directory Idaho

Tuesday 25 September 2012

insulin regular